Program Spending to Increase Adherence South African Cervical Cancer Screening 英文参考文献.docVIP

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Program Spending to Increase Adherence South African Cervical Cancer Screening 英文参考文献.doc

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Program Spending to Increase Adherence South African Cervical Cancer Screening 英文参考文献

ProgramSpendingtoIncreaseAdherence:SouthAfrican CervicalCancerScreening JeremyD.Goldhaber-Fiebert1,2*,LynetteA.Denny3,MichelleDeSouza5,LouiseKuhn4,SueJ.Goldie1 1PrograminHealthDecisionScience,DepartmentofHealthPolicyandManagement,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica, 2CentersforHealthPolicyandPrimaryCareandOutcomesResearch,DepartmentofMedicine,StanfordUniversitySchoolofMedicine,Stanford,California,UnitedStates of America, 3Gynaecology Oncology Unit, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, 4Gertrude H. SergievskyCenter,CollegeofPhysiciansandSurgeons,andDivisionofEpidemiology,JosephL.MailmanSchoolofPublicHealth,ColumbiaUniversity,NewYork,United StatesofAmerica,5KhayelitshaCervicalCancerScreeningProject(KCCSP),CapeTown,SouthAfrica Abstract Background: Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence mustultimatelybeweighedagainsttheassociatedcosts.Wesoughttodeterminetherelationshipbetweeninvestmentin communityhealthworker(CHW)homevisitsandincreasedattendanceatcervicalcancerscreeningappointmentsinCape Town,SouthAfrica. Methodology/PrincipalFindings:Weconductedanobservationalstudyof5,258CHWhomevisitsmadein2003–4aspart ofacommunity-basedscreeningprogram.Weestimatedthefunctionalrelationshipbetweenspendingonthesevisitsand increasedappointmentattendance(adherence).IncreasedadherencewasnotedaftereachsubsequentCHWvisit.Thecosts ofmakingtheCHWvisitswasbasedonresourceuseincludingbothpersonneltimeandvehicle-relatedexpensesvaluedin 2004Rand.TheCHWprogramcostR194,018,with1,576additionalappointmentsattended.Adherenceincreasedfrom74% to90%;55%to87%;48%to77%;and56%to80%for6-,12-,24-,and36-monthappointments.Averageper-womancosts increasedbyR14–R47.Themajorityofthisincreaseoccurredwiththefirst2CHWvisits(90%,83%,74%,and77%;additional cost:R12–R26). Conclusions/Significance: Wefoundthatstudydatacanbeusedforprogramplanning,identifyings